Miura Shinya, Hamamoto Nao, Osaki Masaki, Nakano Satoshi, Miyakoshi Chisato
Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
Ann Thorac Surg. 2017 Apr;103(4):1293-1298. doi: 10.1016/j.athoracsur.2016.08.001. Epub 2016 Oct 6.
The purpose of this study was to explore the prevalence, etiology, and risk factors of extubation failure (EF) in post-cardiac surgery neonates.
Neonates (30 days old or younger) who underwent cardiac surgery and were admitted to the cardiac intensive care unit between September 2010 and February 2016 were included. The prevalence and etiology of EF, defined as reintubation within 48 hours, were reviewed. Demographic, operative, and perioperative data were retrospectively collected. Multiple logistic regression models were constructed to identify the risk factors for EF.
The median age at surgery was 10 days. Extubation failure occurred in 25 of 156 cases (16.0%; 95% confidence interval: 10.6% to 22.7%), because of respiratory dysfunction (n = 16), hemodynamic instability (n = 4), upper airway obstruction (n = 4), or gastrointestinal bleeding (n = 1). Subsequent extubations were successful in 17 cases (68%) because of medical optimization of the causes of reintubation. The remaining 8 cases needed surgical reintervention, including tracheostomy and cardiac surgery. The inhospital mortality rate was 2.6%. In a bivariate analysis, younger age, airway diseases, ventilation before surgery, prolonged mechanical ventilation, and delayed sternal closure were associated with EF. The multivariable analysis identified airway diseases (adjusted odds ratio 18.2, 95% confidence interval: 3.8 to 88.6, p = 0.0003) and mechanical ventilation longer than 7 days (adjusted odds ratio 8.2, 95% confidence interval: 1.9 to 34.9, p = 0.0046) as risk factors for EF.
The prevalence of EF is relatively high in neonatal cardiac surgery. The etiologies can be diverse. Extubation of neonates at high risk after cardiac surgery, based on these possible risk factors, requires more diligent approaches.
本研究旨在探讨心脏手术后新生儿拔管失败（EF）的发生率、病因及危险因素。
纳入2010年9月至2016年2月期间在心脏重症监护病房接受心脏手术且年龄在30天及以下的新生儿。回顾了定义为48小时内再次插管的EF的发生率及病因。回顾性收集人口统计学、手术及围手术期数据。构建多因素logistic回归模型以确定EF的危险因素。
手术时的中位年龄为10天。156例中有25例发生拔管失败（16.0%；95%置信区间：10.6%至22.7%），原因包括呼吸功能障碍（n = 16）、血流动力学不稳定（n = 4）、上呼吸道梗阻（n = 4）或胃肠道出血（n = 1）。由于对再次插管原因进行了医学优化，随后17例（68%）拔管成功。其余8例需要手术再次干预，包括气管切开术和心脏手术。住院死亡率为2.6%。在单因素分析中，年龄较小、气道疾病、术前通气、机械通气时间延长及胸骨闭合延迟与EF相关。多因素分析确定气道疾病（调整优势比18.2，95%置信区间：3.8至88.6，p = 0.0003）和机械通气超过7天（调整优势比8.2，95%置信区间：1.9至34.9，p = 0.0046）为EF的危险因素。
新生儿心脏手术中EF的发生率相对较高。病因可能多种多样。基于这些可能的危险因素，对心脏手术后高危新生儿进行拔管需要更谨慎的方法。
